Spastik hemiplejik serebral palside ayna terapisi uygulamasının beyin reorganizasyonu, fonksiyonel motor beceriler ve yaşam kalitesi üzerindeki etkisi

Öz

Amaç: Spastik hemiplejik serebral palsi, duyusal-motor sorunlar, fonksiyonel hareket ve postür bozuklukları ile karakterize, günlük yaşam aktivitelerini olumsuz etkileyen kompleks bir nöro-gelişimsel bozukluktur. Bu çalışmanın amacı, üst ekstremite ve el fonksiyonlarına yönelik ayna terapisinin beyin yeniden örgütlenmesi, fonksiyonel motor gelişim, günlük yaşam aktiviteleri ve yaşam kalitesi üzerindeki etkilerini incelemekti. Yöntem: Bu özdenetimli çalışma, yaşları 4 ile 18 arasında değişen dokuz çocuktan oluştu. Çocuklar, sekiz haftalık rutin fizyoterapi öncesi ve sonrası değerlendirildi, ardından aynı fizyoterapist tarafından haftada üç gün, 30’ar dakikalık ayna terapisi seanslarını içeren bir müdahale programına alındı. Değerlendirmelerde aktivasyon şiddeti, üst ekstremite aktivasyon yoğunluğu, üst ekstremite beceri düzeyleri, hedef gerçekleştirme durumu, fonksiyonel bağımsızlık düzeyi, beyin yeniden örgütlenme durumu ve yaşam kalitesi ölçüldü. Bulgular: İlk sekiz haftalık takip döneminde, değerlendirme parametreleri açısından istatistiksel olarak anlamlı bir değişiklik saptanmadı (p>0,05). Ancak, ayna terapisinin fizyoterapi programına eklendiği ikinci sekiz haftalık dönemde üst ekstremite becerilerinde, fonksiyonel bağımsızlık düzeylerinde, beyin yeniden örgütlenme bulgularında ve yaşam kalitesinde istatistiksel olarak anlamlı iyileşme görüldü (p<0,05). Sonuç: Bu çalışma, spastik hemiplejik serebral palsili çocuklarda ayna terapisinin etkinliğinin belirlenmesinde fonksiyonel manyetik rezonans görüntüleme (fMRI) kullanımına ilişkin sınırlı literatüre katkı sağlamaktadır.

Anahtar Kelimeler

• Serebral palsi
• Motor beceriler
• Fonksiyonel durum
• Yaşam kalitesi

Effect of mirror therapy on brain re-organization, functional motor skills and quality of life in spastic hemiplegic cerebral palsy

Öz

Purpose: Spastic hemiplegic cerebral palsy is a complex disability with sensory-motor problems characterized by functional movement and posture disorders and negatively effects daily living activities. The aim of this study was to investigate the effects of mirror therapy for upper extremity and hand functions on brain re-organization, functional motor development, daily living activity level, and quality of life in children with spastic hemiplegic cerebral palsy. Methods: This self-control study employed a sample of nine children aged from 4 to 18. The children were evaluated before and after eight weeks of routine physiotherapy and were included in mirror therapy sessions of 30 minutes each for three days a week by the same physiotherapist. The evaluation measured activation intensity, upper extremity activation intensity, upper extremity skill levels, goal achievement states, functional independent states, brain re-organization states, and quality of life levels. Results: No statistically significant difference was detected regarding the evaluation parameters before and after the first eightweek follow-up period (p>0.05). However, a statistically significant improvement was found in upper extremity skill states, functional independence levels, brain re-organization states, and quality of life levels in the second 8-week study period in which mirror therapy was added to physiotherapy (p<0.05). Conclusion: This study contributes to the limited literature on the determination of treatment effectiveness by employing functional magnetic resonance imaging (fMRI) in the mirror therapy on children with spastic hemiplegic cerebral palsy.

Anahtar Kelimeler

• Cerebral palsy
• Motor skills
• Functional status
• Quality of life.

Kaynakça

1. Gordon AM, Bleyenheuft Y, Steenbergen B, et al. Pathophysiology of impaired hand function in children with unilateral cerebral palsy. Dev Med Child Neurol. 2013;55:32-37.
2. Mewasingh LD, Sékhara T, Pelc K, et al. Motor strategies in standing up in children with hemiplegia. Pediatr Neurol. 2004;30:257-261.
3. Rothgangel AS, Braun SM, Beurskens AJ, et al. The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature. Int J Rehabil Res. 2011;12:122-128.
4. Buccino G, Solodkin A, Small SL, et al. Functions of the mirror neuron system: implications for neurorehabilitation. Cogn Behav Neurol. 2006;19:55-63.
5. Rizzolatti G, Craighero L. The Mirror-Neuron System. Annu Rev Neurosci. 2004;27:169-192.
6. Cattaneo L, Rizzolatti G. The mirror neuron system. Arch Neurol 2009;66:557-560.
7. Rizzolatti Cacchio A, De Blasis E, De Blasis V, et al. Mirror therapy in complex regional pain syndrome type 1 of the upper limb in stroke patients. Neurorehabil Neural Repair. 2009;23:792-799.
8. Adler C, Berweck S, Lidzba K, et al. Mirror movements in unilateral spastic cerebral palsy: Specific negative impact on bimanual activities of daily living. Eur J Paediatr Neurol. 2015;19:504-509.

9. Arner M, Eliasson AC, Nicklasson S, et al. Hand function in cerebral palsy. Report of 367 children in a population-based longitudinal health care program. J Hand Surg Am. 2008;33:1337-1347.
10. Altschuler EL, Wisdom SB, Stone L, et al. Rehabilitation of hemiparesis after stroke with a mirror. Lancet 1999;353:2035-2036. Yavuzer G, Selles R, Sezer N, et al. Mirror therapy ımproves hand function in subacute stroke: A randomized controlled trial. Arch Phys Med Rehabil. 2008;89:393-398.
11. McCabe CS, Haigh RC, Ring EFJ, et al. A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1). Rheumatology (Oxford). 2003;42:97-101.
12. Michielsen ME, Selles RW, Van der Geest JN, et al. Motor recovery and cortical re-organization after mirror therapy in chronic stroke patients: A phase II randomized controlled trial. Neurorehabil Neural Repair. 2011;25:223-233.
13. Garrison KA, Winstein CJ, Aziz-Zadeh L, et al. The mirror neuron system: A neural substrate for methods in stroke rehabilitation. Neurorehabil Neural Repair. 2010;24:404-412.
14. Bhasin A, Srivastava MP, Kumaran S, et al. Neural interface of mirror therapy in chronic stroke patients: a functional magnetic resonance imaging study. Neurol India. 2012;60:570.
15. Iacoboni M, Dapretto M. The mirror neuron system and the consequences of its dysfunction. Nat Rev Neurosci. 2006;7:942-951.
16. Gygax MJ, Schneider PN, Christopher J, et al. Mirror therapy in children with hemiplegia: A pilot study. Dev Med Child Neurol. 2011;53:473- 476.
17. Jin-Young P. The effect of mirror therapy on upper-extremity function and activities of daily living in stroke patients. J Phys Ther Sci. 2015;27:1681-1683.
18. Kara KO, Yardimci NB, Sahin S, et al. Combined effects of mirror therapy and exercises on the upper extremities in children with unilateral cerebral palsy: a randomized controlled trial. Dev Neurorehabil. 2020;23:253-264.
19. Limtrakarn W, Tangmanee N, Muengtaweepongsa S, et al. Mirror therapy rehabilitation for lower limb of acute stroke patients. Appl Sci Eng Prog. 2021;15.
20. Russell DJ, Rosenbaum PL, Wright M, et al. Wiley: Gross Motor Function Measure (GMFM- 66 and GMFM-88) User's Manual, 2nd Edition. Basal & Ceiling. 2013;304.
21. Nordmark E, Hägglund G, Jarnlo GB, et al. Reliability of the gross motor function measure in cerebral palsy. Scand J Rehabil Med. 1997;29:25-28.
22. DeMatteo C, Law M, Russell D, et al. The reliability and validity of the quality of upper extremity skills test. Phys Occup Ther Pediatr. 1993;13:1-18.
23. Turner-Stokes L. Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil. 2009;23:362-370.
24. Msall ME, DiGaudio K, Rogers BT, et al. The Functional Independence Measure for Children (WeeFIM): Conceptual basis and pilot use in children with developmental disabilities. Clin Pediatr (Phlia). 1994;33:421-430.
25. Landgraf JM, Abetz L, Ware JE, et al. Child Health Questionnaire (CHQ): A User's Manual. Health Institute, New England Medical Center. 1996;571.
26. Fukumura K, Sugawara K, Tanabe S, et al. Influence of mirror therapy on human motor cortex. Int J Neurosci. 2007;117:1039-1048.
27. Garry MI, Loftus A, Summers JJ, et al. Mirror, mirror on the wall: viewing a mirror reflection of unilateral hand movements facilitates ipsilateral M1 excitability. Exp Brain Res. 2005;163:118-122.
28. Invernizzi M, Negrini S, Carda S, et al. The value of adding mirror therapy for upper limb motor recovery of subacute stroke patients: a randomized controlled trial. Eur J Phys Rehabil Med. 2013;49:311-317.
29. Perry A, Bentin S. Mirror activity in the human brain while observing hand movements: a comparison between EEG desynchronization in the mu-range and previous fMRI results. Brain Res. 2009;1282:126-132.
30. Bruchez R, Gygax MJ, Roches S, et al. Mirror therapy in children with hemiparesis: a randomized observer‐blinded trial. Dev Med Child Neurol. 2016;58:970-978.
31. Feltham Max G, Ledebt A, Deconinck FJA, et al. Mirror visual feedback induces lower neuromuscular activity in children with spastic hemiparetic cerebral palsy. Res Dev Disabil. 2010;31:1525-1535. Michielsen ME, Selles RW, Van der Geest JN, et al. Motor recovery and cortical re-organization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabil Neural Repair. 2011;25:223-233.
32. Summers JJ, Kagerer FA, Garry MI, et al. Bilateral and unilateral movement training on upper limb function in chronic stroke patients: a TMS study. J Neurol Sci. 2007;252:76–82.
33. Stevens JA, Stoykov MEP. Using motor imagery in the rehabilitation of hemiparesis. Arch Phys Med Rehabil. 2003;84:1090-1092.
34. Kuys SS, Edwards T, Morris NR, et al. Effects and adherence of mirror therapy in people with chronic upper limb hemiparesis: a preliminary study. ISRN Rehabilitation. 2012;1-9.
35. Smorenburg Ana RP. The positive effect of mirror visual feedback on arm control in children with spastic hemiparetic cerebral palsy is dependent on which arm is viewed. Exp Brain Res. 2011;213:393-402.
36. Dohle C, Püllen J, Nakaten A, et al. Mirror therapy promotes recovery from severe hemiparesis: A randomized controlled trial. Neurorehabil Neurol Repair. 2009;23:209-217.
37. Park Y, Chang M, Kim K-M et al. The effects of mirror therapy with tasks on upper extremity function and self-care in stroke patients. J Phys Ther Sci. 2015;27:1499-1501.
38. Eom-Ji P, Soon-Hyung B, Soohee P, et al. Systematic review of the effects of mirror therapy in children with cerebral palsy. J Phys Ther Sci. 2016;28:3227-3231.